Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer

Abstract

Background Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial — a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. Methods Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor–patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. Results Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. Conclusion To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.

Increased clinical trial enrollment among adolescent and young adult cancer patients between 2006 and 2012–2013 in the United States

“…5 A recent systematic review of cancer clinical trial enrollment in racial/ethnic minorities identified that although the proportion of adult NH Blacks participating in clinical trials increased from 2000-2010, NH Whites continue to comprise the largest majority of participants in these trials. 29 While racial/ethnic disparities have historically persisted in access to medical care and outcomes, there remain significant opportunities to target this underserved population with the reorganization of NCORP sites specifically designated as Minority/Underserved sites. 30 …”

Barriers and facilitators of clinical trial enrollment in a network of community‐based pediatric oncology clinics

“…Adult clinical oncology trials have documented a disparity of racial and ethnic minorities enrolled, as compared with that of the general population. This disparity limits generalization of the research findings and limits access to novel therapies for racial and ethnic minority participants . A similar disparity of enrollment, albeit to a lesser degree, exists among racial minority participants in pediatric clinical trials .…”

Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers

“…Although language and cultural barriers have been found to impact on trial participation by CALD patients in overseas trials, 6 our analysis suggests language barriers are particularly problematic. CALD patients whose preferred language is not English may be less likely to participate in trials for several reasons.…”